Anxiety brings more people to therapy than any other psychological problem. According to the Public Health Agency of Canada, anxiety disorders affect 12% of the population, meaning over 4 million Canadians. Symptoms range from intense and excessive fear and worry, irritability, difficulty sleeping and concentrating to anxiety (panic) attacks, which may include heart pounding, sweating, shaking and other uncomfortable sensations. Impairment can be mild to severe, affecting social activities, relationships and work and school performance.
In the search for relief, those suffering from anxiety disorders may cope in ways that become problematic: alcohol, drugs, eating disorders, compulsive rituals and other behaviours aimed at escaping the anxiety. Medication is the treatment of choice, but there is little indication that drugs reduce the frequency or severity of symptoms.
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) outlines 9 types of anxiety disorders:
Panic disorder with and without agoraphobia
Generalized anxiety disorder (GAD)
Social anxiety disorder
Obsessive-compulsive disorder (OCD)
Posttraumatic stress disorder (PTSD)
Anxiety secondary to medical condition
Acute stress disorder (ASD)
Substance-induced anxiety disorder
This model outlines what the DSM-IV has labeled Panic Disorder.
The DSM IV Criteria for a Panic Attack are as follows:
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:
1. palpitations, pounding heart, or accelerated heart rate
3. trembling or shaking
4. sensations of shortness of breath or smothering
5. feeling of choking
6. chest pain or discomfort
7. nausea or abdominal distress
8. feeling dizzy, unsteady, lightheaded, or faint
9. derealization (feelings of unreality) or depersonalization (being detached from oneself)
10. fear of losing control or going crazy
11. fear of dying
12. paresthesias (numbness or tingling sensations)
13. chills or hot flashes
The DSM IV outlines Panic Disorder as follows:
A) Both (1) and (2)
(1) recurrent unexpected Panic Attacks
(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
(a) persistent concern about having additional attacks
(b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
(c) a significant change in behavior related to the attacks
B) The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
C) The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
The DSM IV also distinguishes between Panic Disorder and Panic Disorder with agoraphobia, which is outlined as follows:
Panic Disorder is divided into with or without agoraphobia
DSM IV Criteria for Agoraphobia
A) anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.
B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.
C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).
An NLP Model of Anxiety
In this model, I use the word anxiety to refer to the overall pattern and experience of those suffering from this disorder and the word panic to denote the state of mind of intense fear that is a central aspect of this problem.
Denominalizing Anxiety: How Does Anxiety Work?
One of the principal ideas of NLP is that every human experience has a structure. When we look at an experience in this way, we move beyond trying to figure why it occurs and can explore how it works. As one in the vast array of possible human experiences, anxiety is no different; it has a pattern and structure.
The label “anxiety” is deceptive. We refer to anxiety as if it is a thing, but it’s not something we can see or touch. We don’t trip over a pile of anxiety on the street or find some in the kitchen cupboard. It is merely a trick of language that deceives us into thinking about it as if it were an object or thing, freezing a process into something static and condensing a complex pattern into one simple label. In reality, anxiety is a dynamic mental process with emotional and physiological effects.
The word “disorder” is also deceptive. NLP looks at disorders not as fixed things that we have, but more things that we do. To be more accurate, we might say “disordering” instead of disorder and “anxiety-ing” instead of anxiety. These are mental processes that we do, that require out participation to occur. Part of recovery is learning how we do them, as it is often unconscious and automatic, and learning new ways to think (ordering instead of disordering).
The experience of anxiety arises out of a number of psychological building blocks. By unfreezing “anxiety” and “panic” and breaking them down into their components, we can understand how the pieces interact to create these states of mind and also determine how to intervene. This is the basis of therapy with NLP and Neuro-Semantics.
The DSM criteria are useful guidelines for anxiety, but the criteria are somewhat vague and do not indicate methods for intervention. Throught modelling with NLP and Neuro-Semantics we can get more specific about the experience of anxiety and determine effective methods for its resolution.
The Building Blocks of Anxiety and Panic
The Pattern of Anxiety: An Overview
Most cases of moderate to severe anxiety begin with an experience of intense terror or apprehension. Although individuals may say “I’ve always been an anxious person,” most often they can relate an event which fueled the fire and intensified their experience, causing their anxiety to spiral out of control. This event “where it all began” is characterized by such an intense, uncontrollable and unpleasant state of panic that afterward, panic itself becomes the object of fear. The individual becomes driven by the desire to avoid such a state in the future at all costs. The event leads to a persistent fear of future attacks.
If you are in a car accident, when you are on the road again you may be extremely vigilant and take action to avoid another crash. A past unpleasant experience leads you to take action to prevent it from reoccurring. The fear and the action are both justified. The case of panic is different because there are no concrete actions one can take to prevent panicking. The individual wants to avoid such an experience but at the same time is convinced it will reoccur. In a way, they are in a double-bind: they have to avoid it but can’t do anything about it.
Their mental energy is thus taken up by expecting to panic and trying to avoid or prevent it through thinking and worrying, which actually makes it worse.
In many cases, to avoid the possibility of another attack, individuals will avoid places and situations that they expect will induce panic. Avoidance becomes a primary means of coping. In cases of Panic Disorder with agoraphobia, the person rarely or never leaves their in an effort to avoid the terror of panic.
In essence, the initial experience of panic was so marking that it becomes an an imprint experience; the event becomes a powerful memory that restructures the person’s thinking and functions as a template giving them internal signals as to how to think and feel. This kind of experience is an example of “one-trial learning”; due to one traumatic event a person learns an entirely new way of thinking. It only takes one event of panic to lead to the pattern of panic disorder.
The state of mind and pattern that this event leaves in its wake is noteworthy. The fear the individual experiences after the event is not an ordinary state of fear, as it is not a fear of something in the world (known as a primary state in NLP). Rather, it is a fear of one’s own experience; an intense fear of one’s own thoughts and emotions (a meta-state in NLP). Anxiety is fear of fear.
After the event, the person imagines future experiences of panic with a heightened sense of certainty that that experience will indeed occur. They then feel helpless in the face of that impending future. The combination of future expectation, heightened certainty, helplessness and apprehension about the whole experience lead to the uncontrollable state we call “anxiety.”
Expectation — Certainty — Helplessness — Apprehension = Anxiety
Each of these states fuels and drives the others, keeping the pattern in place. If any of these levels of experience is altered, the person will begin to recover. For example, if one begins to feel that they could panic in the future instead of thinking they will panic, the anxiety diminishes. If they begin to feel that it they may panic, but if they do they can cope and they’ll be fine, the anxiety also reduces.
Why does this occur?
Surprisingly, the pattern of anxiety is actually the solution to a problem. In the face of perceived danger, the mind adapts and finds a way to cope. If you’re in danger, your survival instinct takes over to keep you safe. The pattern of anxiety is a way to keep you safe. Such a pattern may have had an evolutionary function in human history, helping us avoid things that hurt us in the past and keeping us from putting ourselves in unnecessary danger. In a modern society however, where we are generally safe and survival is rarely a major concern, excessive anxiety is unnecessary and is ineffective at keeping us safe. The pattern is based on the assumption that the individual is in danger when in reality, the danger is over.
Anxiety and Neuro-Linguistic Programs
In order to function, a computer must run software programs. Without the software, a computer can’t do a whole lot. The programs installed on a computer enable us to achieve all sorts of tasks from playing games to completing our taxes.
To function, we also need software. It is our unique programming that allows us to operate in the world and accomplish all sorts of things. Our individual programs are signals that guide how we think, feel and act.
We have programs to:
Relate to and communicate with others
Deal with challenges and setbacks
Accomplish tasks and achieve goals
Interpret and understand events and circumstances
And the list goes on.
According to NLP, these programs are thought of as Neuro Linguistic Programs.
What is it that makes up human experience? In exploring how people created their individual and distinct subjective experiences, the co-founders of NLP broke human experience down into its building blocks.
The fives senses and physiology (our neurology)
Every human experience involves and combines the five senses in some way. For example, to have anxiety, one must vividly imagine unwanted future scenarios.
Kinesthetic (feeling and touch)
This includes which senses we are using for a certain experience, how much we’re using them, how we’re using them and in what sequence. Which modality is dominant and which ones are absent?
Every human experience has a certain physiology. For example, being depressed requires looking down, limiting movement and shallow breathing. It gets hard to maintain the state if you’re doing jumping jacks or running a marathon.
Eye accessing cues
Breathing (speed and depth)
The words we use to describe our experience also shape our experience. By labeling, classifying and categorizing our experience we create various subjective experiences and states of mind.
According to the above, our “programs” are made up of:
- Which senses were using and how we’re using them
- How we’re using our body
- What language we are using
These are called programs in part because, according to NLP thinking, they are not hardwired, but learned patterns. If they are learned patterns, we can alter them and update those one which aren’t working for us. In short, we can learn new programs in order to function more effectively in life.
Any human skill or problem can be understood by uncovering the Neuro Linguistics that drive it.
Anxiety and The Hypnotic Effects of Language
According to NLP, anxiety and panic are Neuro-Linguistic experiences. What this means is that they are created in us by the use of our senses, body (physiology) and our language. To experience anxiety, we have to use our mind, body and our language in very specific ways. If we change any of these elements, we find ourselves in different states of mind, thinking differently and engaging in different behaviours.
I encourage clients to use words other than anxiety for this same reason. Once, I was working with a client who kept saying “I’m anxious.” I asked him how he felt when he used those words. His answer was no surprise to me: “I feel more anxious.” My response was this: “What could you call this experience that would be more useful for you?” He sat back for a moment and thought before he answered, “Being concerned.” I asked him how he felt when he described it that way; “More calm,” he said.
Anxiety is not the experience, it is merely the label. The same is true of the word panic. We have an experience with our senses (we see images, hear words or sounds and feel feelings) and then we put words to it. Once we label something, we mistake the label for the experience itself, but they are different, and how we label something affects our experience of it.
Some people might say, “But I need to stay true to my feelings.” But anxiety is not the feeling, panic is not the feeling, they are merely the labels. We don’t want to lie about how we feel or be inauthentic with ourselves, but we do want to use more effective language. Often we’ve never examined the words we are using and so we disempower ourselves with outdated labels. And anxiety has become a buzzword.
The words we use have a hypnotic effect on us. Where does you mind go when you hear the word “democracy” or ‘freedom” “love” or “Nazism”? These words are vague, lacking in specificity and so they send the mind on a search. We have to search through our own experience and bring to mind associations, memories or ideas to make sense of these words. Using words like “anxiety” and “panic” becomes a form of self-hypnosis. The more one says them, the more they feel the feelings and think the thoughts that are associated with them. Where does your mind go when you use words such as peace, calm, confidence, balance etc. Saying to yourself “I want to be calm” instead of “I don’t want to be anxious” sends your mind in a new direction.
The NLP strategy model shows the sequence of mental events one goes through to experience anxiety.
Internal dialogue -> imagery -> feelings
Those suffering from anxiety characteristically ask themselves, “What if I have a panic attack” which then leads them to imagine it occurring: In their mind they play a movie of themselves panicking or experiencing other unwanted situations that must be avoided (going crazy, passing out etc.) By vivdly imagining these worst case scenarios, they literally put themselves into a state of fear. The more they try to avoid anxiety, the more anxious they feel. Anxiety occurs because trying to avoid panic actually leads to panic.
The study of hypnosis reveals a type of hypnotic phenomena known as ideosensory trance. In ideosensory trance, a person vividly experiences sights and sounds in their mind. Essentially, as one thinks about a sensory response, they create vivid mental imagery and then experience the imagined response. In this way, the experience of anxiety is a sort of hypnotic trance; the person is literally hypnotizing themselves into a state of fear.
What keeps the pattern running is that this strategy is most often out of awareness. The individual is aware of the feeling and sensations, which are really the symptoms and not the cause.
The experience of anxiety is driven by internal dialogue that is out of control. The person actually talks themselves into a panic. “What if” questions are common, usually followed by scenarios to be avoided (panic, passing out, going crazy) as are phrases such as “Oh my God.” The continuous and incessant internal voice is the opposite of what is occurring when one is in a state of peace or calm.
Though it is not the words alone that intensify the unpleasant emotions. What amplifies the fear and worry into panic are the qualities of this voice: The internal dialogue is fast, loud and the tonality worried. Consider how you feel when someone yells at you vs. when someone speaks to you with a calm voice.
It is possible for an individual to think of worst-case scenarios without feelings of anxiety, so what makes the difference? According to the NLP model, it is the submodalities of the pictures that amplify the emotional response and give the individual the sense that their expectation is a certainty and not merely a possibility. Pictures of unwanted future scenarios are usually large, close, in colour, bright and vivid, giving the mind the signal that they are real and imminent. They may actually be movies rather than still pictures, which also serves to increase the emotional intensity. The individual struggling with anxiety is fixated on horror movies in their own mind.
As the initial experience could be considered a form of trauma, the mind and body find ways to cope. The pattern of anxiety forms as the solution to a problem: danger. Characteristic of cases of Panic Disorder is a type of dissociation in which a “part” of the person is split off. In a way, it like a distinct personality that lies dormant at times and takes over at others when triggered by anxiety-inducing stimuli.
This “anxiety part” has it’s own way of thinking, it’s own belief system, which differs markedly from the individuals normal way of thinking. This explains why they can say that they know the anxiety is illogical and irrational, but it still occurs.
This part also has its own agenda. Most often, its purpose is safety and protection. During or after the original traumatic event, this part split off as an adaptation. In the face of danger, this part formed with the purpose of safety and protection.
Another type of hypnotic phenomena is evident here: regression. The thinking of this part is akin to a child that feels helpless in the face of danger. A part like this is then in conflict with the person’s rational views. It feels the person is in danger and since it has the intelligence of a child, won’t question it’s own paradigm. It becomes inflexible and militant about its objective. In a way, this part acts as a defense mechanism pushing the person into a pattern of fear and avoidance.
Hypervigilance of body functioning
Because of their sense of danger and the expectation that they will panic, normal body functions and changes can be interpreted in ways that fuels the anxiety. Aspects of our experience such as breathing and heartbeat are automatic and normally out of conscious awareness. Heightened awareness or hypervigilance of bodily functions is an interesting experience. The suffer of anxiety may become of normal changes in heartbeat and think think something is wrong with their heart or they are about to have another panic attack (or a heart attack). Already apprehensive, they may notice their breathing and feel that they can’t breath or that their breathing is restricted, which may lead to hyperventilation. They may notice bodily pains and interpret them as meaning something is terribly wrong or they have an undiagnosed illness. Efforts to control breathing or heartbeat will worsen the problem as these processes can only function properly when they are automatic.
The Meta-Programs of Anxiety
Meta-Programs are thinking, communication and behavioural styles. In essence, they are like the lenses we wear when interpreting the world and so, shape our interpretation of it. Any human experience can be understood by exploring the meta-programs that help to create it and examining how they interact and influence the interpretation of information.
Away from motivation
The pattern of anxiety is characterized by excessive avoidance of possible internal experiences. Anxiety is not fear, it is fear of fear. By wanting to avoid unpleasant experiences, the individual creates them. This is know is NLP as an away from meta-program. Because the person is so focused on what is to be avoided (panic, heart attack, illness, loss of control) that they have nothing to move toward. Without an outcome, they keep running in circles within the anxiety system. Use of a toward meta-program, meaning focusing on what is desired and to move toward (ie. peace, comfort, control), is required for change to occur. Instead of avoiding anxiety, panic and fear, the individual needs to learn how to move toward calm, peace, confidence etc.
Optimists tend to expect that things will turn out well, problems will be solve and believe there is light at the end of the tunnel. Optimists are best-case thinkers as they tend to expect the best. Pessimists, or worst-case thinkers, tend to expect catastrophe. When things go wrong, they’re convinced that the worst-case scenario is the most likely. It is worst-case thinking that drives the pattern of anxiety. Combined with away from motivation, the person spends their mental energy avoiding imagined worst-case scenarios. More optimistic ideas such as “I am alright,” “I’ll be fine,” “I’ll recover,” “I can handle this” are not part of their thinking.
Some people are active in that they take charge, take responsibility, take action towards their goals. Others tend to think, wait, analyze and consider. The anxious individual is most skilled at thinking and analyzing. This skill becomes destructive when they think about, analyze and worry about the worst-case scenarios they want to avoid. The combination of these three meta-programs leaves little possibility for effective action or progress. Instead, it keeps them going around in circles.
Mapped At Cause
A second element that keeps the pattern in place is that the individual is convinced that the anxiety is something that “happens” to them. With so many elements of the pattern out of awareness, this is no surprise. Also, if the pattern of anxiety functions as a defense, then the defense has to hide itself from the radar. If it is found out, the cover is blown. To function, any defense needs to hide itself or it no longer works.
Inherent in the language that individuals suffering from anxiety use to describe this type of problem are expressions that put control of the problem out of their hands. Psychologically, they think of it as something that happens to them instead of a result they have an active part in producing. The wording of “panic attack” is interesting in and of itself as it implies that panic attacked. Few clients sit down at the therapist’s office and say “I was walking along and panic stepped around the corner and attacked me.” The reality is, panic does not attack. It is not a thing, nor a force or an entity. It cannot attack you.
Change requires that the cause of the problem be attributed to it’s source, which, in the case of anxiety, is a certain way of using one’s mind, ie. beliefs, internal dialogue, imagined scenarios etc. Instead of saying, “I had a panic attack,” I encourage clients to language their experience in ways such as “I worked myself up,” “I freaked myself out,” or any other way of putting it that is useful for them and moves them beyond labels that leave them powerless. This puts them back in control of their own experience.
Anxiety Model Summary
An initial memory of an experience of intense fear or panic. Because this experience was so unpleasant, the individual wants to avoid it. They are convinced it will happen again and want to avoid it. Other memories may play a factor as well.
Internal dialogue -> imagery -> feelings
They ask themselves, “What if I have a panic attack” which then leads them to imagine this occurring: in their mind they play a movie of themselves panicking or experiencing other unwanted situations that must be avoided.
Auditory Digital Submodalities: Loud, fast, close, worried or fearful tone.
Visual Submodalities: Close, large, in colour, bright, moving,
The initial experience causes a part to be split off, essentially an anxiety part. This part believes they are in danger and turns to primitive defenses (such as avoidance) to maintain safety. This explains why the anxiety sufferer will know intellectually that the anxious thoughts are irrational or unnecessary, but feel powerless to do anything about it.
Away from motivation:Excessive avoidance instead of clear objectives to move toward.
Not at cause: Anxiety is thought of as something that happens to them, not as a process they engage in. Panic is seen as something that attacks them, as they are unaware of how they intensify their emotions (internal dialogue, tone of voice, pictures).
How Do We Resolve Anxiety?
1. Understanding anxiety and it’s symptoms.
No one can overcome a psychological problem that they attribute to external causes. The first step is to understand that anxiety is not a thing that attacks you nor something that ‘happens’ to you, but a result one obtains by doing specific things with their mind. The model presented above outlines each of the pieces and how they contribute to creating states of anxiety and panic.
2. Recoding Memories
Since the unpleasant memories are acting as a template telling the individual how to think and feel, how these memories are coded must be modified. Processes that can be used for this are:
• Time Line Therapy
• The trauma cure
These processes will lead to greater peace and control.
3. Learning to Direct Internal Dialogue
As the anxiety sufferer has lost control of their own internal dialogue, they must learn how to use it in ways that lead to other states.
Through NLP submodality interventions, one learns to alter the qualities of the voice – slowing the speed, lowering the volume, changing the tone, etc. As one does this, they’ll find that changing the qualities of the voice changes the resulting emotions. By turning the volume all the way down, they can turn the voice off completely and enter more calm and peaceful states.
It will also be helpful to learn more effective internal dialogue:
Instead of “What if I panic?” they can begin to direct their mind with more helpful questions such as ” How can I stay calm?” They can also learn to break their own pattern of anxiety by saying things to themselves such as “Shup up!”
The anxiety experience is driven by a part convinced of impending danger that is split off from the rest of the person. NLP offers several interventions to resolve this inner conflict such as:
• Parts integration
• Parts negotiation
• Core transformation
Each of these processes will lead to greater peace and alignment inside.
5. Kinesthetic Sensations
Although people rarely notice, different feelings move in different directions in the body. Each time I’ve worked with an anxiety sufferer, they will make the same gesture when describing their anxiety or nervousness. The gesture mirrors how the feeling moves in their body. Here we can ask, “Where does the feeling start and where does it go?” The response, (eg. “It starts in my stomach and it moves up to my throat) will reflect the gesture, in this case a clockwise hand motion.
Individuals can learn to enter instant states of calm and relaxation with a technique called “Spinning the Feeling” from Richard Bandler’s Neuro-Hypnotic Repatterning.
Anxiety is not a thing, it is an experience made of building blocks. The psychological pieces lead to emotions and behaviours. By making changes to these building blocks, the result is greater control and peace of mind.